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Thoracic and Lumbar Spine Anatomy. Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C. Clinical Anatomy. Vertebral Column: Cervical Spine: Lordotic curvature Greatest ROM Most vulnerable to injury Thoracic Spine: Greatest protection Least ROM Lumbar Spine:

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thoracic and lumbar spine anatomy

Thoracic and Lumbar Spine Anatomy

Orthopedic Assessment III – Head, Spine, and Trunk with Lab

PET 5609C

clinical anatomy
Clinical Anatomy
  • Vertebral Column:
    • Cervical Spine:
      • Lordotic curvature
      • Greatest ROM
      • Most vulnerable to injury
    • Thoracic Spine:
      • Greatest protection
      • Least ROM
    • Lumbar Spine:
      • Balance between protection/ROM
clinical anatomy1
Vertebral Column:

Extends from skull to the pelvis

33 total vertebrae:

Superiorly: 24 individual vertebrae (separated by intervertebral discs)

Inferiorly: 9 fuse to form 2 composite bones

Sacrum (5)

Coccyx (4)

Clinical Anatomy
clinical anatomy2
Vertebral Column:

Functions:

Transmits weight of the trunk to the lower limbs

Surrounds/protects spinal cord

Attachment point for the ribs and muscles of neck and back

Clinical Anatomy
clinical anatomy3
Vertebral Column: Major Supporting Ligaments

Anterior Longitudinal Ligament – runs vertically along anterior surface of vertebral bodies

Neck - Sacrum

Attaches strongly to both vertebrae and intervertebral discs (very wide)

Prevents back hyperextension

Clinical Anatomy
clinical anatomy4
Vertebral Column: Major Supporting Ligaments

Posterior Longitudinal Ligament-runs vertically along posterior surfaces of vertebral bodies

Narrower, weaker

Attaches to intervertebral discs

Prevents hyperflexion

Clinical Anatomy
clinical anatomy5
Vertebral Column: Major Supporting Ligaments

Ligamentum Flavum - strong ligament that connects the laminae of the vertebrae

Protects the neural elements and the spinal cord

Stabilizes the spine to prevent excessive vertebral body motion

Strongest of the spinal ligaments

Forms the posterior wall of the spinal canal with the laminae

Stretches with forward bending / recoils in erect position

Clinical Anatomy
clinical anatomy6
Vertebral Column: Supporting Ligaments

Intertransverse Ligament - located between the transverse processes

Cervical region: consist of a few irregular, scattered fibers

Thoracic region: rounded cords connected with deep muscles of the back

Lumbar region: thin and membranous

Clinical Anatomy
clinical anatomy7
Vertebral Column: Supporting Ligaments

Interspinal Ligament - connect spinous processes (spans the entire process)

Meets the ligamentum flavum in front and the supraspinal ligament behind

Clinical Anatomy
clinical anatomy8
Vertebral Column: Supporting Ligaments

Supraspinal Ligament -connects together the apexes of the spinous processes

Extends from 7th cervical vertebra to sacrum

Strong fibrous cord

At points of attachment (tips of the spinous processes) fibrocartilage is developed in the ligament

Clinical Anatomy

Supraspinal Ligament

clinical anatomy9
Clinical Anatomy
  • Bony Anatomy:
    • Body : Centrum
      • Anterior part
      • Weight-bearing segment
    • Vertebral Arch: Neural Arch
      • Posterior part
      • Formed by pedicle and lamina on each side
clinical anatomy10
Bony Anatomy:

Vertebral Foramen:

Opening

Pedicles: (2)

Sides of vertebral arch

“Little feet” project posteriorly from body

Laminae: (2)

Flat roof plates

Complete arch posteriorly

Clinical Anatomy

Thoracic Vertebrae

clinical anatomy11
Bony Anatomy:

Transverse Processes:

Project laterally from each pedicle-lamina junction

Attachment site for intrinsic ligaments and muscles

Spinous Processes:

Prominent posterior projections

Attachment site for intrinsic ligaments and muscles

Clinical Anatomy
clinical anatomy12
Clinical Anatomy
  • Facet Joints:
    • Articulations between superior articular facet (bottom vertebrae) and inferior articular facet (above vertebrae)
    • Contribute to ROM
    • ↓ Weight-bearing stress through vertebral body and disc
    • Synovial joints
clinical anatomy13
Clinical Anatomy
  • Pars Interarticularis:
    • Area between the superior and inferior facets
    • Common site for stress fractures (lumbar spine)
    • Spondylolysis - refers to the defect (black arrows) present when the pars interarticularis (green arrow) is fractured
clinical anatomy14
Clinical Anatomy
  • Intervertebral Foramen:
    • Space where spinal nerve roots exit the vertebral column
    • Size variable due to placement, pathology, spinal loading, and posture
      • Can be occluded by arthritic degenerative changes and space-occupying lesions (tumors, spinal disc herniations)
clinical anatomy15
Clinical Anatomy
  • Thoracic Segment:
    • Wider/thicker – help support torso weight
    • Spinous Processes:
      • Downward projection
        • Limit extension
        • Attachment for thoracic muscles/ligaments
    • Transverse Processes:
      • Costotransverse Joints:
        • Articulation with ribs
        • Ribs 1 – 10
        • Ribs 11 and 12
          • No articulation with transverse processes
clinical anatomy16
Clinical Anatomy

Costovertebral

Joint

Costotransverse

Joint

clinical anatomy17
Clinical Anatomy
  • Thoracic Segment:
    • Costovertebral Joint:
      • Articulation between vertebral bodies and ribs
      • Superior and Inferior Costal Facets

Superior Costal Facet

Inferior Costal Facet

clinical anatomy18
Sacrum:

Curved, triangular shaped

5 fused vertebrae

Fixes the spinal column to the pelvis

Stabilizes the pelvic girdle

Clinical Anatomy
clinical anatomy19
Clinical Anatomy
  • Sacroiliac Joint (SI):
    • Between the sacrum (base of the spine) and the ilium of the pelvis
    • Strong, weight bearing synovial joints (2)
      • Covered by 2 different kinds of cartilage
        • Sacral surface (hyaline cartilage)
        • Iliac surface (fibrocartilage)
    • Functions:
      • Shock absorption (spine)
      • Allows the transverse rotations (lower extremity) to be transmitted up the spine.
    • Motions:
      • Anterior innominate tilt
      • Posterior innominate tilt
      • Sacral flexion (or nutation)
      • Sacral extension (or counter-nutation)
clinical anatomy21
SI Ligaments:

Anterior Sacroiliac Ligament:

Connects the anterior surface of the lateral part of the sacrum to the ilium

Clinical Anatomy

Note: Black Arrow

clinical anatomy22
SI Ligaments:

Posterior Sacroiliac Ligament:

Forms the chief bond of union between the bones

Upper part: (short PSL)

Nearly horizontal in direction

Ilium to upper sacrum

Lower part: (long PSL)

Oblique in direction

Lower sacrum to PSIS

Clinical Anatomy

Short PSL

Long PSL

clinical anatomy23
SI Ligaments:

Sacrotuberous Ligament:

Arises from ischial tuberosity to blend in with inferior fibers of posterior SI ligaments

Clinical Anatomy

Sacrotuberous Ligament

Ischial Tuberosity

clinical anatomy24
SI Ligaments:

Sacrospinous Ligament:

Originates from the ischial spine and attaches to the coccyx

Clinical Anatomy

Sacrospinous Ligament

clinical anatomy25
Coccyx: Tailbone

Consists of 4 (in some cases 3 or 5) vertebrae fused together

Attachment site for muscles of pelvic floor and sometimes portions of gluteus maximus

Clinical Anatomy
clinical anatomy26
Intervertebral Discs:

23 intervertebral discs

No disc between skull and C1 or between C1-C2

Discs are thickest in the lumbar vertebrae and cervical regions (enhances flexibility)

Functions:

Shock absorbers

walking, jumping, running

Allow spine to bend

At points of compression, the discs flatten out and bulge out a bit between the vertebrae

Clinical Anatomy
clinical anatomy27
Nucleus Pulposus: Core

Gelatinous, acts like a rubber ball (enables spine to absorb compressive forces)

60-70% water

Annulus Fibrosus: Outer rings

Multilayered fibers (cross from opposite directions)

Rings absorb compressive forces themselves

Clinical Anatomy
clinical anatomy28
Clinical Anatomy
  • Intervertebral Discs: Dehydration Process
    • Collectively, the discs make up about 25% of the height of the vertebral column
    • Nucleus pulposus becomes dehydrated during course of day
      • Flattens out (height is 1-2 centimeters less at night than when we awake in morning)
      • Aging Process = Permanent dehydration (ages 40 – 60)
        • Decreased ROM
        • Narrowing intervertebral foramen
clinical anatomy29
Lumbar and Sacral Plexus:

Lumbar:

Formed by 12th thoracic nerve and L1-L5 nerve roots

Innervation:

Anterior and medial muscles of thigh

Dermatomes of medial leg and foot

Femoral Nerve – formed by branches of L2, L3, L4 nerve roots

Obturator Nerve – anterior branches of L2, L3, L4

Clinical Anatomy
clinical anatomy30
Lumbar and Sacral Plexus:

Sacral:

Formed by L4, L5 and lumbosacral trunk

Innervation:

Muscles of buttocks, posterior femur, and lower leg

Sciatic Nerve – 3 sections

Tibial nerve

Common peroneal nerve

Tibial nerve

Clinical Anatomy
clinical anatomy32
Lumbarization:

1st sacral vertebrae does not unite with sacrum

Becomes a 6th lumbar vertebrae

Sacralization:

5th lumbar vertebrae becomes fused to sacrum

Clinical Anatomy
clinical anatomy33
Clinical Anatomy
  • Extrinsic Muscles – primarily function to provide respiration and movement associated with the upper extremity and scapula
    • Indirectly influence the spinal column
  • Intrinsic Muscles – lie close to spinal column
    • Directly influence the spinal column
clinical anatomy34
Middle Trapezius:

O: Lower portion of ligamentun nuchae and spinous processes of C7 and T1 – T5

I: Acromion process, scapular spine

A: Scapular retraction and fixation of thoracic spine

Clinical Anatomy
clinical anatomy35
Lower Trapezius:

O: Spinous processes of T8 – T12

I: Scapular spine (medial portion)

A: Scapular depression and retraction; fixation of thoracic spine

Clinical Anatomy
clinical anatomy36
Rhomboid Muscles:

Rhomboid Major and Minor

O: Spinous processes of C7 through T5

I: Vertebral border of scapula between the spine and inferior angle

A: Scapular retraction, elevation, and downward rotation; Fixation of thoracic spine

Clinical Anatomy
clinical anatomy37
Latissimus Dorsi:

O: Spinous processes of T6 through T12 and the lumbar vertebrae via the thoracodorsal fascia, posterior iliac crest

I: Intertubercular groove of humerus

A: Extension of spine, anterior rotation of pelvis, stabilization of lumbar spine (depression of shoulder girdle, humeral extension)

Clinical Anatomy
clinical anatomy38
Rectus Abdominis:

O: Pubic crest and symphysis

I: Xiphoid process and costal cartilages of 5th, 6th, and 7th ribs

A: Trunk flexion; compression of abdomen

Clinical Anatomy
clinical anatomy39
External Oblique:

O: 5th through 12th ribs

I: Iliac crest and linea alba

A: Bilaterally: trunk flexion; compression of abdomen; Unilaterally: lateral bending; rotation to opposite side

Clinical Anatomy
clinical anatomy40
Internal Oblique:

O: Inguinal ligament, iliac crest, thoracolumbar fascia

I: Tenth, eleventh, and twelfth ribs; linea alba, crest of pubis

A: Bilaterally: Trunk flexion, compression of abdomen; Unilaterally: lateral bending and rotation to same side

Clinical Anatomy
clinical anatomy41
Erector Spinae: 3 muscle pairs

Iliocostalis:

Iliocostalis Lumborum

Iliocostalis Thoracis

Iliocostalis Cervicis

Longissimus:

Longissimus Thoracis

Longissimus Cervicis

Longissimus Capitis

Spinalis:

Spinalis Thoracis

Spinalis Cervicis

Spinalis Capitis

Clinical Anatomy
clinical anatomy42
Transversospinal Muscles:

Deep intrinsic layer

Fibers run from 1 transverse process to the spinous process superior to them

Group formed by:

Semispinalis

Multifidus

Rotators

Clinical Anatomy